MEDICARE: MISS VANESSA VILLAR COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA13017	FL

General Provider Information

NPI Number	:	1972936359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VANESSA VILLAR COTA/L

Provider Business Mailing Address
First Line	:	8125 NW 192ND TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5207
Country	:	US
Telephone Number	:	305-582-6149
Fax Number	:

Provider Business Practice Location Address
First Line	:	8125 NW 192ND TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5207
Country	:	US
Telephone Number	:	305-582-6149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/20/2013

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